8/2/2019 Adrenal Hyper Function

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INDICATIONS FOR TESTING

Suspected Cushing Syndrome

(Central obesity, muscle weakness,

refractory hypertension)

Adrenal Hyperfunction (Cushing Syndrome) TestingClick here for topics associated with this algorithm

Cortisol Urine Free

by LC-MS/MS

Cortisol, Saliva

(tested at

midnight)

OR

0.112 g/dL 60 g/day male

>45 g/day femaleyesno

normal

Repeat

Cortisol, Saliva

(tested at

midnight)

0.112 g/dL normal

Cushing Syndrome

unlikely; no further

testing

normal

Repeat

Cortisol Urine Free

by LC-MS/MS

>60 g/day male>45 g/day female

normal

Cushing

Syndrome

likely

Low dose dexamethasone suppression test (DST) protocol:1 mg dexamethasone PO (taken between 11 pm and 12 am)

Then measure at 8 am the following morning:

Cortisol, Serum or Plasma

(or Cortisol Urine Free by LC-MS/MS)

Cushing Syndrome

unlikely; no further

testing

Urine cortisol